Coronary Heart Disease Women and Heart Disease

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Coronary heart disease is the leading cause of death for women. Two out of three women have one or more risk factors for coronary heart disease, and this increases with age. Having multiple risk factors greatly increases a person’s chance of developing coronary heart disease.

• Hormone changes may affect a woman’s risk for coronary heart disease. Before menopause, the  hormone  estrogen provides women with some protection against heart disease. However, as women age, their risk for coronary heart disease increases. Taking hormones to relieve  symptoms of menopause can further increase that risk. Women who experience early menopause, especially after surgical removal of the uterus, are more likely to develop heart disease than women of the same age who have not yet experienced menopause.
• The size and structure of the heart is different for women and men. A woman’s heart and blood vessels are smaller, and the muscular walls of women’s hearts are thinner.
• Women are more likely to have heart disease in the tiny  arteries of the heart, called coronary microvascular disease. This can make the disease harder to identify and cause delays in treatment.

• Different activities bring on chest pain. In men, angina tends to worsen with physical activity and go away with rest. Women are more likely to have angina while they are doing routine daily activities, such as shopping or cooking, rather than during exercise. 
• The location and type of pain may differ. Pain symptoms are different for each person. Both women and men having angina or a heart attack often describe their chest pain as crushing, or that it feels like pressure, squeezing, or tightness. Women also may have pain in the chest or the neck and throat. Microvascular angina events may last longer and be more painful than other types of angina.
• Mental stress is more likely to trigger angina pain in women than in men.
• Other symptoms common for women include nausea, vomiting, shortness of breath,  abdominal pain, sleep problems, tiredness, and lack of energy.

FACT SHEET

The TRUTH About Women and Heart Disease

Heart disease affects women of all ages. Learn more about heart disease and actions to keep your heart healthy.

View the fact sheet

Certain risk factors for coronary heart disease are unique to or more common in women compared with men. 

Medical conditions and lifestyle factors 

Some health conditions are more common in women, or raise their risk of coronary heart disease more than men, including:

• Diabetes
• Low levels of high-density lipoprotein HDL cholesterol (sometimes called “good” cholesterol)
• Mild to moderate high blood pressure, especially after age 65
• Smoking
• Autoimmune and inflammatory diseases
• Lack of physical activity
• Mental health problems such as stress, marital problems, anxiety, depression, or low social support
• Metabolic syndrome, a group of risk factors that raises your risk for heart disease and other health problems
• Overweight and obesity

Reproductive health and pregnancy

Women may have higher risk for coronary heart disease because of pregnancy-related or other reproductive factors:

• Anemia, especially during pregnancy
• Early menopause (before age 40) 
• Endometriosis
• Hormonal birth control
• Gestational diabetes 
• Preeclampsia and eclampsia (high blood pressure during pregnancy) 
• Having a preterm birth or delivering a baby that is smaller than average
• Polycystic ovarian syndrome
• Menstruation that started at a young age

Learn more about coronary heart disease risk factors for women and how to lower them.

Heart disease is the main cause of pregnancy-related deaths in the United States. Complications are more common in pregnant people who are age 35 or older, or who have health conditions that are risk factors for coronary heart disease.

Pregnancy in people who already have coronary heart disease is risky. About 1 in 10 will have some type of heart complication while pregnant or within a year after giving birth. 

If you have heart disease and are pregnant or planning a pregnancy, it is important to consult with your cardiologist (a doctor who specializes in heart health) and with an obstetrician (a doctor who specializes in the care of pregnant people). Specialized pregnancy care can lower the chance of a serious complication that could affect you or your baby.

Tests and procedures for diagnosing coronary heart disease are similar for women and men, but women may experience delays in diagnosis or treatment. Know how to get the best information:

• Ask about important diagnostic tests. Healthcare providers may be less likely to refer women for diagnostic tests for coronary heart disease. When women go to the hospital for heart-related symptoms, they may be more likely than men to experience delays in receiving an initial electrocardiogram, less likely to receive care from a heart specialist when hospitalized, and less likely to receive some treatments and medicines. Younger women are more likely than men to be misdiagnosed and sent home from the emergency department after cardiac events caused by undiagnosed and untreated microvascular heart disease.
• Ask about treatment options that are effective for both women and men. Women may be less likely than men to receive medicines, devices, and procedures to treat their heart disease, even when research shows that both women and men benefit.  
• Know and share your risk factors. Healthcare providers may not understand women’s unique risk factors for coronary heart disease. Commonly used risk scoring systems may not accurately predict risk in women.
• Learn the symptoms and seek medical care right away. Immediate care may help prevent complications such as a heart attack or sudden cardiac arrest.